Kerstein J, Pauly M V, Hillman A
Baruch College, City University of New York.
Health Serv Res. 1994 Apr;29(1):17-37.
We assess whether physician turnover stems from incorrect physician expectations about the practice environment or from actual constraints or rewards in that environment.
Our primary data source contains information about individual HMOs' primary care physicians incentive mechanisms and general HMO characteristics. Our secondary data source is the area resource file (ARF), which contains countywide information about the HMOs' market areas, including physician characteristics, population characteristics, and other market characteristics.
Our primary data source is from a nationwide survey of all HMOs in operation in 1987-1988, as reported to Interstudy.
We find that turnover is higher on the part of physicians whose HMO enrollment comprises a greater percentage of their total practice. Our results further indicate that physicians whose compensation is dependent on the behavior of a group of other physicians are more likely to leave the plan than those who bear the risk (and control it) more directly. On the other hand, turnover is increased by basing bonuses on individual productivity and by not sharing surpluses among a group. Market characteristics also are significant in explaining physician turnover in HMOs.
It appears that physicians accurately forecast how they will react to individual financial risk, although they dislike restrictions imposed by HMOs.
我们评估医生流动是源于医生对执业环境的期望有误，还是源于该环境中的实际限制或回报。
我们的主要数据源包含有关各个健康维护组织（HMO）的初级保健医生激励机制以及HMO总体特征的信息。我们的次要数据源是区域资源文件（ARF），其中包含有关HMO市场区域的全县范围信息，包括医生特征、人口特征和其他市场特征。
我们的主要数据源来自1987 - 1988年对所有运营中的HMO进行的全国性调查，调查结果已上报给Interstudy。
我们发现，在其HMO注册患者占其总业务量比例更高的医生中，流动率更高。我们的结果进一步表明，薪酬取决于一组其他医生行为的医生比那些更直接承担风险（并控制风险）的医生更有可能离开该计划。另一方面，基于个人生产力发放奖金以及不在一组医生中分享盈余会增加流动率。市场特征在解释HMO中的医生流动方面也很重要。
看起来医生能够准确预测他们对个人财务风险的反应方式，尽管他们不喜欢HMO施加的限制。
